Category Archives: Healthcare Partners

The Importance of Apologies

Marie Prothero received the college’s 2016 Alumni Achievement Award in recognition for her contribution to the nursing profession. This article contains excerpts from her BYU Homecoming address, delivered October 13, 2016.

“I believe that for us to move healthcare forward into achieving quality healthcare and outcomes, [we must] have transparency,” says Marie Mellor Prothero (MS ’96), MSN, RN, FACHE. A nurse administrator, Prothero is the executive director of quality for St. Mark’s Hospital in Salt Lake City. She oversees quality assurance for her organization that includes electronic reporting, patient concerns, and physician compliance. She also strives to improve process flow and safety efforts.

Prothero is currently working on a PhD in nursing from the University of Utah; her dissertation is focused on transparency in healthcare and the role of an apology following a medical error.

The attributes of an apology include expressing regret and sorrow, admitting fault with a statement that an error occurred, listening with dignity and respect, correcting the mistake and ensuring it will not happen again, and offering restitution to the victim.

Her studies highlight several antecedents, such as why we apologize and the corollaries of not apologizing when there is a medical mistake or accident.

“We must realize [that the] consequences of not apologizing affects our emotional, spiritual, and physical well-being,” says Prothero. “And if left unresolved, [mistakes] can create feelings of bitterness and even increase litigation and settlement costs.”

To give an effective apology, one must express regret and sorrow; you cannot fully apologize without remorse. “A conversation casually informing a patient of the error is inadequate,” says Prothero, “and so is a statement that seems forced and insults others’ intelligence.” Appropriately apologizing takes the right setting and practice.

Prothero’s research serves as a starting point for additional inquiry to explore the nature and types of apologies. It will help other nurse leaders identify what comes after the apology and if the patient-provider relationship can be repaired.

“There must be ongoing communication as additional details are learned—with the patient and family members, as well as with unit staff and hospital administrators,” she says. “Once we identify system changes, we need to involve others in the process to ensure needs are met and proper training occurs.”

Further, Prothero’s studies clarify the role of nursing in disclosure, apology, and the creation of a culture of safety in which everyone feels valued and able to speak up. “We must continue the important work of quality assurance, process improvement, and system improvement,” she says. “Never forget that every patient matters.”

She also emphasizes that nurses have the opportunity to be leaders with a broad impact in their organization.

“Leadership is interdisciplinary and [is] a team approach,” she says. “You must know your strengths and weaknesses and understand what you bring to the team. Then surround yourself with people who are different from you and learn from each other for success.”

Prothero has been a leader her whole career. Before St. Mark’s, she was the CEO of Utah Valley Specialty Hospital in Provo for seven years, a CEO of Ernest Health for four years, and an operations officer with Intermountain Healthcare for 22 years.

“Never stop learning and developing your nursing and leadership skills,” she concludes. “Success comes from ensuring the success of your peers. Take time to remove roadblocks, recognize achievement, and encourage others. By being a positive influence, you can see the best in your team.”

 

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Immunization Exemptions and Pediatric Care

As a family nurse practitioner working in a pediatric outpatient clinic, assistant teaching professor Lacey Eden (BS ’02, MS ’09) educates parents about the general health of their child. Eden frequently addresses parents’ questions and concerns regarding immunizations for their child due to the requirement that parents provide either proof of completion or a certificate of exemption before their child can be enrolled in school.

Because of her experiences talking with parents about immunizations, Eden decided to research the rising immunization exemption rates in Utah. She is currently working on a standardized education module for immunization exemptions and also a mobile app called Best for Baby.

Education Model for Immunization Exemption Rates

Immunization exemption rates, particularly those granted for philosophical reasons, have risen drastically in Utah over the last few years. The rise in exemptions may have played a role in several recent outbreaks of vaccine-preventable diseases (measles and pertussis) in Utah, which prompted Eden to research the education provided for parents who wish to obtain an exemption. Currently she is investigating the specific education requirements for philosophical immunization exemptions in all states across the country and how effective this education is at combating the rise in exemption rates.

In her research, Eden found that all 50 states allow medical exemptions for immunizations, 48 states allow religious exemptions, and 18 states allow philosophical exemptions. Utah is one of the 18 states that allows all three types of exemptions. While 18 states allow philosophical exemptions, only 14 states require education before granting exemptions. The type of education parents receive varies from state to state and from county to county throughout Utah.

Eden has discussed her study with several prominent leaders of various associations and departments, including the health director and the immunization manager at the Utah State Health Department and the chair of the Utah Department of Human Services, in efforts to implement a standardized education module for Utahns to complete in order to gain a philosophical immunization exemption. She has also been invited to participate on an immunization exemption task force with several key participants in the state and with fellow College of Nursing faculty—Dr. Beth Luthy (MS ’05), Gaye Ray (AS ’81), Dr. Janelle Macintosh, and Dr. Renea Beckstrand (AS ’81, BS ’83, MS ’87). This task force is charged with creating a standardized education module that can teach parents the signs and symptoms of diseases, what to do if their child contracts a disease, and what to do in the case of an outbreak. The module will also answer frequently asked questions about immunizations and provide information about obtaining low-cost immunizations.

The Association of Immunization Managers and the Centers for Disease Control and Prevention have contributed to this project by aiding in the data-collection process and reviewing the research questions on educational requirements in reducing immunization exemptions.

Best for Baby App

In 2013, the Advisory Committee on Immunization Practices (ACIP) published its recommendation that pregnant women should get a Tdap vaccination between 27 and 36 weeks of pregnancy. Infants do not receive this vaccine until two months of age, but in the womb they do inherit temporary protective antibodies from their mothers, so it is essential for mothers to receive the vaccine and pass antibodies to their children in utero.

Despite being recommended by the ACIP, very few women receive the Tdap vaccine during their third trimester, so Eden, who serves as chair of the Utah County Immunization Coalition, decided to educate soon-to-be parents through a free mobile-device app called Best for Baby (now available on iTunes).

Though geared toward increasing Tdap immunization rates, the app does much more than just teach about vaccines. The program sends expectant parents weekly push notifications that provide updates on their baby’s development and when they need to see their OB/GYN. Additionally, updates tell parents what tests to expect at their next appointment, what those tests look for, and why they are performed. The app continues to give parents monthly push notifications for two years after the birth of the child. These updates include when the child should see a care provider, what developmental milestones he or she should reach during the month, and what immunizations that child should receive.

Oh, It’s a Jolly Holiday with Leslie! Yoga and Fingerpainting Are Back In Style In Nursing Relaxation

Note: To offer more insight into the lives of nursing students, we are sending Steven, a writer for the College of Nursing, to the weekly Nursing Stress Management Course. Steven is a Middle East Studies/Arabic major. This post contains the summaries of two of the previous classes, with the first focusing on yoga and the second on fingerpainting.

Part One: On Pain, Reflexology, and Yoga Nidra

I showed up to the stress management class excited, ready to finger-paint. I noticed quickly that everyone was wearing comfortable clothes, and was informed that there had been a change. It was now yoga day, and I was in jeans.

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Students prepare to follow instructor Maria in yoga.

Yoga and I have always had an interesting relationship. Once while visiting the mission doctor, his wife had made me do intensive yoga while I waited, a process that just barely fell short of violating the eighth amendment’s ban on cruel and unusual punishment.

I thought that I had escaped, but I was later called in to translate for a meeting with her and my mission president, in which to my horror I found myself communicating my mission president’s desire for her to teach yoga to the entire mission. That’s how the Chile Santiago North Mission found itself doing yoga at zone conferences in suits and ties, and how I became a wanted man.

For the class, we had an instructor named Maria who teaches therapeutic yoga as a way to help patients recover from medical issues. Maybe, just maybe, she could de-stress a bunch of Type A nursing students and an Arabic major doing yoga in a button up.

We started by rolling a racquetball under our feet. This was based on the ideas of reflexology, a school of thought that says that points on the hands and feet are connected to the rest of the body. By relieving those points, you can relieve other areas like the back.

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Students massage their feet with racquetballs. Reflexology says that this will help them take pressure off various points in their bodies.

Now came real yoga. We did moves that aimed to help our muscles relax. We bent over, twisted, and performed various motions. Through it all, I found myself slowly starting to feel a bit less tense. All the while, Maria explained the benefit of each move. At one point, she told assistant teaching professor Leslie Miles that we would be working on something to help her back.

“Yay, we’re going to fix me!” she cried out in glee. We all were repeating that statement in our heads.

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Maria shows students how to prepare for the puppy pose.

One of our final move combinations was first to put our legs against the wall and leave them there for several minutes. Then we laid on our backs and adjusted our feet so that our backs had less pressure.

That was when it happened—I suddenly felt asleep, but I was awake. It was a weird, halfway point. I stayed in that immensely relaxed state for a few minutes until it was time to get up, upon which Maria informed me that I had been in yoga nidra. I’m still not sure what that means, but it was nice.

By the end of the session, I felt more relaxed, as usual. This class is so helpful for figuring out the ways to de-stress that best work for each person.

Now, if you come across me with my legs propped against the wall not talking, just keep walking. It’s just yoga nidra.

 

Part Two: Oh, It’s a Jolly Holiday with Leslie!

It was the afternoon. Students milled around, hauling large sheets of paper and eagerly grabbing the paint. Fingers were saturated in orange, blue, red, yellow, and purple as they worked to create masterpieces. Sometimes it got on the desks, but the teacher was used to this.

Spoiler: this isn’t a kindergarten class. This is nursing stress management, and I may or not have been the main culprit behind the paint on the desk (I cleaned it up!).

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Students gather supplies for painting and coloring.

Assistant teaching professor Leslie Miles had brought in lots of paper, both to color and to fingerpaint. Everyone was excited. Today was art and music therapy day, possibly the most anticipated class of the term.

After reviewing our stress levels in groups, we proceeded to discuss how music aids relaxation. Miles explained that not all music is equal in this area—songs with various chord changes are better suited than many modern songs, which are simply repetitive. She impersonated a rap song, but my life would be in jeopardy if I dared repeat it here.

With that, we each got our supplies and began our artistic adventures. In the background, Miles was blaring one of her favorite albums—the original Mary Poppins soundtrack.

I began a relentless campaign to replace every white spot on my paper with some color. In the end, my creation resembled many of my friends returning home from the Festival of Colors.

Others, however, were superbly done. Miles was surprised at the quality of the artwork, and I was surprised at how each student seemed to be focused wholly on the project and not any impending nursing deadlines.

I could go on, but pictures here do more justice than words.

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The Magic Yarn Project and BYU Team Up to Make Wigs for Childhood Cancer Patients

Last Saturday in what turned out to be a landmark service project, over 400 people crowded the Wilkinson Center ballroom to create Disney-themed wigs for kids with cancer. The project, sponsored by The Magic Yarn Project and the BYU College of Nursing, was a massive success.

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The Magic Yarn Project co-founder Holly Christensen works with volunteers to prepare a Moana wig.

“I did not expect to have so many people show up,” Holly Christensen, a BYU College of Nursing alumna and co-founder of The Magic Yarn Project, says.

The Magic Yarn Project is a non-profit group started by Christensen in Alaska. It relies entirely on donors and volunteers to make the soft-yarn hairpieces, so the BYU event represented a huge increase in both productivity and publicity.

“We’ve never done a workshop this big,” she says. “I’m completely touched and overwhelmed by how many people came and it’s hard for me not to get too emotional thinking about it but it’s been awesome.”

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Volunteers make Moana-inspired wigs

During the course of the five-hour project, 185 wigs were made, with styles ranging from Elsa to Jack Sparrow to Rapunzel and other Disney-related characters. This was a record number for the Magic Yarn Project, and during the event, many participants were touched by the potential impact of their work.

“I really enjoyed this,” student Dhina Clement says. “I definitely felt like this was the most productive that I have ever been.”

Nursing student Jessica Wright agrees. “This is an awesome volunteer experience because you feel like what you’re doing is helping someone,” she says. “You can imagine having the wig on a little girl’s head and how happy she’ll be when she sees it.”

Students were not the only ones working—many members of the wider Utah Valley community arrived, oftentimes with large amounts of children in tow in order for many hands to make light work.

“I heard about this through a friend from work, and I thought it was just a great idea to come and just put my effort into it for any of the kids who need it,” says Esme Still, whose children worked beside her. In addition, five nursing professors were also present braiding and preparing wigs.

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The Wilkinson Center ballroom was completely full of volunteers. 185 wigs were made in the five-hour project.

Around half of the wigs made at this event will be given to patients at Primary Children’s Hospital, while others will be sent to patients in Louisiana and Arizona. The impacts of the project, however, extend also to the participants, who felt grateful to have been able to contribute to the event.

“I think it’s a really good opportunity to bring some joy to some people and it was really easy and fun and simple,” student Sam Smith says. “It’s nice to wake up on a Saturday morning and do something for someone else.”

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Anyone interested in future volunteer opportunities with The Magic Yarn Project should visit http://www.themagicyarnproject.com/.

Students Learn the Balancing Act at the “Struggle to Juggle” Conference

Yesterday, the BYU College of Nursing hosted its annual Professionalism Conference.  Students listened to speakers, attended breakout sessions on topics related to overcoming the rigors of nursing life, and met prospective employers.

“The thing that I like most about this is that I think it helps you be aware of the things that will be coming,” says capstone student Ashea Hanna, who is slated to graduate in April.

Others also gained a lot from the theme of the conference, which was “Struggle to Juggle.” Breakout topics ranged from healthy eating to handling compassion fatigue, while others treated financial independence and nursing ethics.

“It helped me learn how to balance a couple of things like sleep and self-care, but then also broaden my perspective a little,” fourth-semester student Micai Nethercott says.

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Capstone student McCall Van Leeuwen particularly enjoyed the breakout session held by a non-nursing professional, since it offered the chance to feel appreciated as a student nurse and become aware of her possible positive impact on others.

Meanwhile, back in the Garden Court over fifteen booths were set up with representatives from various hospitals and agencies proffering information to students about future job opportunities.

One such station was for Wyoming State Hospital, which is roughly 100 miles away. There a decorative poster highlighted the offered $29 per hour wage for new nursing graduates.

“We need nurses and [BYU’s program is] a great nursing program,” expressed one representative of the hospital when asked why they had come so far. This sentiment was common among vendors, many of whom had various open positions they hoped students could fill.

Jesse, a representative of Intermountain Healthcare’s Dixie Regional Medical Center, had several students express interest in working in St. George.

“We’ve had quite a few, and most of them are very excited,” he said. He and his colleagues liked that the conference brought students close to them and offered students different opportunities to seek employment with various groups at assorted places.

In the end, the conference managed to help students understand how to take care of themselves and their careers during future years, all while enjoying a free lunch.

“Overall, it’s just really good helping me understand the balance I need in my future career,” capstone student Bethany Borup says.

 

 

Enrichment in Education, Part Four: Simulation is the Sincerest Form of Flattery

This story is part of an ongoing series about the BYU College of Nursing’s Mary Jane Rawlinson Geertsen Nursing Learning Center and the College’s constant efforts to update it.

This past summer, sixteen BYU College of Nursing faculty and staff received three days of intensive simulation training. The process, one could say, has modeled a path to success for any nursing college.

The course, offered by Intermountain Healthcare and hosted at LDS Hospital, was tailored specifically to the needs of BYU staff. It was in part the brainchild of assistant teaching professor Stacie Hunsaker, who, after six years of working with simulation, felt that it would be beneficial to standardize the training that college employees received.

“They held a course for us, and it was great because as a team we were able to experience specific issues to our simulation and work on very specific items related to BYU nursing, so it was really helpful for us to be there as a team,” Hunsaker says.

After receiving a thick binder full of notes, the teachers were taught important ideas about using simulation in instruction, including the need for establishing good communication between students and helping them get engaged in the activities.

“By going to that course, all of us were able to get that same consistent information, so now we can hopefully provide a better experience for the students of all semesters who participate in simulation,” Hunsaker says.

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NLC Supervisor Colleen Tingey works with other staff to practice simulation drills intended to benefit students.

Part of the process was participating in and creating scenarios; it was as though the teachers became the students as they practice different situations and were critiqued on how they performed. Staff also worked to implement new ideas into existing simulations as well as develop new ones for this year’s teaching.

“We were able as groups to develop objectives for all of our simulations and then put them into consistent formats throughout all semesters,” Hunsaker says. “So now we have all of them set up so that they’ll have a prebrief, a simulation, and a debriefing moment.”

Getting everyone on the same page was a key motivator to implement the training, and the college is making all efforts to preserve the progress made. Now all new staff will be able to take the course when hired, and there are two meetings a semester to evaluate how well simulation principles are being applied in the classrooms.

While the training may be costly, Dean Patricia Ravert believes that simulation is “really integral to our program” and thus merits the effort to advance it.

“We want to have a top-notch program, which we do, and we want to maintain that,” she says. “We want to make sure that the students really have great experiences.” Both she and Hunsaker believe that the training establishes a stronger base of unity and understanding among the simulation staff.

“It really brings us together as a team because we all have the same foundation now,” Hunsaker says. “We all know we can all give good, valid information, not that it was bad before, but I think that it just brought everything together and provided so much consistency. Now we’re all using the same terminology. We all know how a sim is supposed to run.”

 

Dr. Stephanie L. Ferguson To Address Nursing College Event

 

This year’s annual Scholarly Works Conference brings a special treat for BYU nursing students: a chance to hear from the world-renowned nursing expert Dr. Stephanie L. Ferguson.

Dr. Ferguson has years of experience in the health industry. She founded and is president of a health-consulting firm that has clients all over the world. Her travels have seen her visit over 140 countries.

Her employers have included the World Health Organization and the White House. Leadership has been a defining character of her career, with positions including:

  • Elected member of the National Academy of Medicine/Institute of Medicine
  • Member of the Board of Trustees of the U.S. Catholic health Association
  • Director of the International Council of Nurses’ Leadership for Global Change Programme
  • Co-chair of the American Academy of Nursing’s Institute for Nursing Leadership
  • Director of the Washington Health Policy Institute in the Center for Health Policy, Research and Ethics
  • Director of the ICN-Burdett Global Nursing Leadership Institute, located in Switzerland

Dr. Ferguson’s topic is “Building and Sustaining Healthy Nations: Leading the Way Forward.” While registration for the conference is now closed, the college will provide information next week about Dr. Ferguson’s presentation, as well as about select breakout sessions.